Lumbar Endoscopic Spinal Decompression Cadaver Course September 24-25

Cadaver Workshop Venue
Medical Education and Research Institute
44 South Cleveland, Memphis, TN 38104 |(901) 722-8001| (800) 360-6374
Hilton Memphis
939 Ridge Lake Boulevard
Memphis, TN 38120

**This course is open to physicians only*

Personal Information:

First Name:*

Middle Initial:

Last Name:*

Organization:

Address:*

City:*

State:*

Zip:*

Phone:*

Cell:

Fax:

E-mail:*

Please answer all of the following questions:

Medical Degree:*

MDDOPhDOther

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Primary Specialty Certification:*

AnesthesiologyNeurologyPhysiatryOther

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Pain Medicine Subspecialty Certification*

American Board of Medical Specialties (ABA, ABPMR, ABPN, etc.)American Osteopathic Association of (AOA)American Board of Interventional Pain Physicians (ABIPP)American Board of Pain Medicine (ABPM)Fellow in Interventional Pain Practice (FIPP)Competency in Interventional Pain ManagementOther

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Fellowship Training*

Pain MedicineSpine SurgerySports MedicineOther

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Years in Interventional Pain Management practice:*

01-56-10More than 10

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Number of Years Experience in Lumbar Spinal Endoscopic Decompression*

01-56-10More than 10

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Please indicate the total number of procedures during the past year for each of the procedures below.

Lumbar Disc Decompression*

L5-S1 Disc Decompression*

Lumbar Spinal Decompression for Spinal Stenosis*

L5-S1 Lumbar Spinal Decompression for Spinal Stenosis*

Lumbar Decompression for Spondylolisthesis*

L5-S1 Decompression for Spondylolisthesis*

Lumbar Decompression for Disc Extrusion*

L5-S1 Decompression for Disc Extrusion*

Lumbar Discography*

Lumbar Interlaminar*

Lumbar Transforaminal *

Payment Information

Cadaver lab has limited spaces. Early registration is encouraged.

Cadaver Workshop -- Member$4,250.00

Cadaver Workshop--Non-Member$4,500.00

Total $0.00

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COVID POLICY

ASIPP holds our meetings and workshops safely and responsibly. We require all attendees and faculty to be vaccinated and/or have a COVID test 3 days prior to the meeting or one day prior for rapid testing. We will also have rapid test kits on site for those who might arrive unvaccinated or untested.

CANCELLATION POLICY:

ASIPP reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded, however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation for cadaver workshops. ASIPP requires a 30-day notice of cancellation for cadaver workshops. Cancellations for cadaver workshop after August 26, 2022 but prior to September 10, 2022 will forfeit 50% of their registration fee. No refunds can be made after September 10, 2022.

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